Working Toward Mission Zero

Note: Originally published in the NH Union Leader, June 11, 2024

Holding people in hospital emergency departments because inpatient mental health services are unavailable (“ED boarding”) has been a hot topic in New Hampshire and across the country. While the waitlist has led to finger-pointing between participants in the mental health system, ED boarding is a source of tremendous suffering for people already in their darkest time, and pain and frustration for their families.

Today, we see reasons for hope. The waitlist has been as low as single digits in recent weeks, and consistently half as high as it was a year ago. How did this occur? Last summer, the New Hampshire Department of Health and Human Services (DHHS) announced “Mission Zero,” a bold commitment and comprehensive strategy to eliminate ED boarding among adults. The initiative recognizes that zero people waiting for care is the only acceptable goal.

Aligned with the 10-Year Mental Health Plan, Mission Zero has infused major resources and attention for New Hampshire to overcome this urgent, complex challenge once and for all.

Mission Zero brings together a network of stakeholders to tackle ED boarding head on through a multi-layered strategy that addresses three key drivers of the challenge we see in New Hampshire:

Lack of services available in the community that would more effectively prevent or address a psychiatric crisis;

An inadequate volume and coordination of inpatient resources;

Delayed discharge from inpatient care due to a lack of supportive community-based services.

To ensure services are available before someone is in crisis, we are expanding our community behavioral health model, providing increased availability of integrated mental health and substance use disorder treatment — by this summer, a third of the Granite State’s community mental health centers will have received preliminary certification for this modernized model.

We have also funded two community-based crisis stabilization centers, which provide short-term care and community-based referrals. One center, operated by the Center for Life Management, is already serving 45-60 people per month who might otherwise go to an emergency department. The second center, operated by Lakes Region Mental Health, is scheduled to open soon. We expect to support the launch of additional crisis stabilization centers in 2025.

When someone is in crisis and in need of inpatient care, we have launched Care Traffic Control, a first-of-its-kind coordination and oversight hub in which hospitals submit referrals for inpatient mental health treatment to support timely care in the right place.

New Hampshire Hospital works daily with our hospital partners to review and refine this new approach, leading to data-driven improvements and more timely placements. We are also right-sizing the number of inpatient psychiatric beds.

Through effective project oversight and employee recruitment and retention, New Hampshire Hospital has brought an additional 18 beds online in recent months, increasing the census to 170 patient beds with plans to reach full capacity of 184 beds by the end of the year.

We have also partnered with SolutionHealth and Dartmouth Health to establish additional beds for those who require acute, episodic treatment and a smooth and supported return to community.

Finally, once someone is ready to be discharged, expanded offerings help individuals with complex needs successfully return to their community. We have supported the transitions of 14 individuals with nursing home needs to less restrictive community-oriented care; will see two new five-bed specialty residential programs at full capacity next month; and we expect to introduce similar programming in the future.

We are also helping individuals transition to supportive housing with community-based services by working with rental property owners, landlords, and municipalities on strategies that mitigate risks and provide permanent, supportive housing for people with mental health needs. An expanded landlord incentive program will also create opportunities for 25 people to move to stable, supportive housing before the end of 2024.

All of this is supported by more than $50 million due to the shared commitment of Gov. Chris Sununu and the New Hampshire Legislature, including $5 million provided to community health centers just recently, to support our outpatient community mental health system.

All of the work of Mission Zero is being brought to life through the collective efforts of the multi-sector coalition who joined us in launching and sustaining it. Our coalition includes hospital representatives, government officials, and advocates, such as NAMI NH, whose engagement ensures that our work is informed by the experiences of people in New Hampshire affected by mental illness.

Mission Zero is a call to action that meeting the needs of people with mental health issues in the right setting is our only acceptable future state. If we fulfill our vision of making ED boarding a thing of the past and become a model for the country, it will not be due to one entity, one sector, or one strategy. It will be due to the deep humility and fierce collaboration it takes to finally get it right.

If you or someone you know is experiencing mental health, substance use or other behavioral health issues, please call or text 833-710-6477 for help, 24 hours a day, 7 days a week.

Lori A. Weaver, Commissioner
NH Department of Health and Human Services